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Review of the Relationship between C-Reactive Protein and Exercise

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Abstract

C-reactive protein (CRP), an acute phase reactant, is associated with systemic inflammation. Many studies have demonstrated that CRP levels have important prognostic implications for patients. For example, individuals with elevated CRP levels have an increased risk of cardiovascular events. The JUPITER study showed that reducing CRP levels can mitigate this risk. Various trials have investigated the effect of lifestyle modifications on serum CRP levels. Specifically, the impact of different exercise-based protocols on CRP levels has been researched. This review article evaluates the response of CRP levels to aerobic-based, resistance-based, and combination exercise protocols. Furthermore, it examines the impact of such regimens in children, adults, and the elderly.

No definitive answers exist regarding the relationship between exercise and CRP levels. Significant reductions in CRP levels were noted in 11 of 25 trials of aerobic-based regimens, two of five studies of combination protocols, and neither of two trials of resistance-based regimens. Similar findings were seen across all age groups. There were significant CRP reductions in nine of 18 adult studies, four of ten child studies, and one of three elderly studies. Mixed results reflect uncertainty about the ability of exercise to reduce inflammation. Various mechanisms, including increased protein synthesis and fat loss, have been proposed to explain the potential anti-inflammatory effects of exercise.

While exercise-based regimens have produced inconsistent results, lifestyle modifications do appear to have significant anti-inflammatory effects. This was particularly evident in studies that utilized combined diet/exercise programs. Significant CRP reductions were seen in five of seven such trials. Interestingly, both studies with failed combination protocols achieved substantial CRP reductions in their diet-only groups. These findings suggest that weight loss is important in reducing inflammation. Additionally, they indicate that combined diet/exercise protocols should be part of any lifestyle intervention program. Further research will be needed to identify optimal regimens for achieving anti-inflammatory benefits.

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References

  1. Heikkila K, Ebrahim S, Lawlor DA. A systematic review of the association between circulating concentrations of C reactive protein and cancer. J Epidemiol Community Health 2007; 61: 824–33

    Article  PubMed  Google Scholar 

  2. Jabs WJ, Busse M, Kruger S, et al. Expression of C-reactive protein by renal cell carcinomas and unaffected surrounding renal tissue. Kidney Int 2005; 68: 2103–10

    Article  PubMed  CAS  Google Scholar 

  3. Johnson TV, Abbasi A, Owen-Smith A, et al. Absolute preoperative C-reactive protein predicts metastasis and mortality in the first year following potentially curative nephrectomy for clear cell renal cell carcinoma. J Urol 2010; 183: 480–5

    Article  PubMed  CAS  Google Scholar 

  4. Johnson TV, Abbasi A, Owen-Smith A, et al. Postoperative better than preoperative C-reactive protein at predicting outcome after potentially curative nephrectomy for renal cell carcinoma. Urology 2010; 76: 766.e1–5

    Article  CAS  Google Scholar 

  5. Johnson TV, Young AN, Osunkoya AO, et al. C-reactive protein as a clinically useful biomarker of metastasis of renal cell carcinoma. Mol Diagn Ther 2010; 14: 191–3

    Article  PubMed  Google Scholar 

  6. Karakiewicz PI, Hutterer GC, Trinh QD, et al. C-reactive protein is an informative predictor of renal cell carcinoma-specific mortality: a European study of 313 patients. Cancer 2007; 110: 1241–7

    Article  PubMed  CAS  Google Scholar 

  7. Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008; 359: 2195–207

    Article  PubMed  CAS  Google Scholar 

  8. Johnson TV, Master VA. Non-malignant drivers of elevated C-reactive protein differ in patients with and without a history of cancer. Mol Diagn Ther 2010; 14: 295–303

    Article  PubMed  CAS  Google Scholar 

  9. Kelley GA, Kelley KS. Effects of aerobic exercise on C-reactive protein, body composition, and maximum oxygen consumption in adults: a meta-analysis of randomized controlled trials. Metabolism 2006; 55: 1500–7

    Article  PubMed  CAS  Google Scholar 

  10. Campbell PT, Campbell KL, Wener MH, et al. A yearlong exercise intervention decreases CRP among obese postmenopausal women. Med Sci Sports Exerc 2009; 41: 1533–9

    Article  PubMed  Google Scholar 

  11. You T, Berman DM, Ryan AS, et al. Effects of hypocaloric diet and exercise training on inflammation and adipocyte lipolysis in obese postmenopausal women. J Clin Endocrinol Metab 2004; 89: 1739–46

    Article  PubMed  CAS  Google Scholar 

  12. Donges CE, Duffield R, Drinkwater EJ. Effects of resistance or aerobic exercise training on interleukin-6, C-reactive protein, and body composition. Med Sci Sports Exerc 2010; 42: 304–13

    PubMed  CAS  Google Scholar 

  13. Rosenbaum M, Nonas C, Weil R, et al. School-based intervention acutely improves insulin sensitivity and decreases inflammatory markers and body fatness in junior high school students. J Clin Endocrinol Metab 2007; 92: 504–8

    Article  PubMed  CAS  Google Scholar 

  14. Balagopal P, George D, Patton N, et al. Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents. J Pediatr 2005; 146: 342–8

    Article  PubMed  Google Scholar 

  15. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004; 291: 2978–84

    Article  PubMed  CAS  Google Scholar 

  16. Esposito K, Pontillo A, Di Palo C, et al. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA 2003; 289: 1799–804

    Article  PubMed  CAS  Google Scholar 

  17. Kadoglou NP, Iliadis F, Angelopoulou N, et al. The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus. Eur J Cardiovasc Prev Rehabil 2007; 14: 837–43

    Article  PubMed  Google Scholar 

  18. Kelly AS, Wetzsteon RJ, Kaiser DR, et al. Inflammation, insulin, and endo-thelial function in overweight children and adolescents: the role of exercise. J Pediatr 2004; 145: 731–6

    Article  PubMed  CAS  Google Scholar 

  19. Hammett CJ, Oxenham HC, Baldi JC, et al. Effect of six months' exercise training on C-reactive protein levels in healthy elderly subjects. J Am Coll Cardiol 2004; 44: 2411–3

    Article  PubMed  Google Scholar 

  20. Rauramaa R, Halonen P, Vaisanen SB, et al. Effects of aerobic physical exercise on inflammation and atherosclerosis in men: the DNASCO study: a six-year randomized, controlled trial. Ann Intern Med 2004; 140: 1007–14

    PubMed  Google Scholar 

  21. Heffernan KS, Jae SY, Vieira VJ, et al. C-reactive protein and cardiac vagal activity following resistance exercise training in young African-American and White men. Am J Physiol Regul Integr Comp Physiol 2009; 296: R1098–105

    Article  PubMed  CAS  Google Scholar 

  22. Levinger I, Goodman C, Peake J, et al. Inflammation, hepatic enzymes and resistance training in individuals with metabolic risk factors. Diabet Med 2009; 26: 220–7

    Article  PubMed  CAS  Google Scholar 

  23. Klimcakova E, Polak J, Moro C, et al. Dynamic strength training improves insulin sensitivity without altering plasma levels and gene expression of adipokines in subcutaneous adipose tissue in obese men. J Clin Endocrinol Metab 2006; 91: 5107–12

    Article  PubMed  CAS  Google Scholar 

  24. Misra A, Alappan NK, Vikram NK, et al. Effect of supervised progressive resistance-exercise training protocol on insulin sensitivity, glycemia, lipids, and body composition in Asian Indians with type 2 diabetes. Diabetes Care 2008; 31: 1282–7

    Article  PubMed  CAS  Google Scholar 

  25. Lindegaard B, Hansen T, Hvid T, et al. The effect of strength and endurance training on insulin sensitivity and fat distribution in human immunodeficiency virus-infected patients with lipodystrophy. J Clin Endocrinol Metab 2008; 93: 3860–9

    Article  PubMed  CAS  Google Scholar 

  26. Munk PS, Staal EM, Butt N, et al. High-intensity interval training may reduce in-stent restenosis following percutaneous coronary intervention with stent implantation: a randomized controlled trial evaluating the relationship to endothelial function and inflammation. Am Heart J 2009; 158: 734–41

    Article  PubMed  Google Scholar 

  27. Stewart LK, Flynn MG, Campbell WW, et al. The influence of exercise training on inflammatory cytokines and C-reactive protein. Med Sci Sports Exerc 2007; 39: 1714–9

    Article  PubMed  CAS  Google Scholar 

  28. Villareal DT, Miller 3rd BV, Banks M, et al. Effect of lifestyle intervention on metabolic coronary heart disease risk factors in obese older adults. Am J Clin Nutr 2006; 84: 1317–23

    PubMed  CAS  Google Scholar 

  29. Farpour-Lambert NJ, Aggoun Y, Marchand LM, et al. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol 2009; 54: 2396–406

    Article  PubMed  CAS  Google Scholar 

  30. Murphy EC, Carson L, Neal W, et al. Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. Int J Pediatr Obes 2009; 4: 205–14

    Article  PubMed  Google Scholar 

  31. Barbeau P, Litaker MS, Woods KF, et al. Hemostatic and inflammatory markers in obese youths: effects of exercise and adiposity. J Pediatr 2002; 141: 415–20

    Article  PubMed  Google Scholar 

  32. Meyer AA, Kundt G, Lenschow U, et al. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol 2006; 48: 1865–70

    Article  PubMed  Google Scholar 

  33. Kelly AS, Steinberger J, Olson TP, et al. In the absence of weight loss, exercise training does not improve adipokines or oxidative stress in overweight children. Metabolism 2007; 56: 1005–9

    Article  PubMed  CAS  Google Scholar 

  34. Tsang TW, Kohn M, Chow CM, et al. A randomized controlled trial of Kung Fu training for metabolic health in overweight/obese adolescents: the “martial fitness” study. J Pediatr Endocrinol Metab 2009; 22: 595–607

    PubMed  CAS  Google Scholar 

  35. Isasi CR, Deckelbaum RJ, Tracy RP, et al. Physical fitness and C-reactive protein level in children and young adults: the Columbia University Bio-Markers Study. Pediatrics 2003; 111: 332–8

    Article  PubMed  Google Scholar 

  36. Roberts CK, Chen AK, Barnard RJ. Effect of a short-term diet and exercise intervention in youth on atherosclerotic risk factors. Atherosclerosis 2007; 191: 98–106

    Article  PubMed  CAS  Google Scholar 

  37. Kelishadi R, Hashemi M, Mohammadifard N, et al. Association of changes in oxidative and proinflammatory states with changes in vascular function after a lifestyle modification trial among obese children. Clin Chem 2008; 54: 147–53

    Article  PubMed  CAS  Google Scholar 

  38. Carrel AL, McVean JJ, Clark RR, et al. School-based exercise improves fitness, body composition, insulin sensitivity, and markers of inflammation in non-obese children. J Pediatr Endocrinol Metab 2009; 22: 409–15

    Article  PubMed  Google Scholar 

  39. Wong PC, Chia MY, Tsou IY, et al. Effects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesity. Ann Acad Med Singapore 2008; 37: 286–93

    PubMed  Google Scholar 

  40. Lee TM, Lin MS, Chang NC. Usefulness of C-reactive protein and interleukin-6 as predictors of outcomes in patients with chronic obstructive pulmonary disease receiving pravastatin. Am J Cardiol 2008; 101: 530–5

    Article  PubMed  CAS  Google Scholar 

  41. Ikonomidis I, Andreotti F, Economou E, et al. Increased proinflammatory cytokines in patients with chronic stable angina and their reduction by aspirin. Circulation 1999; 100: 793–8

    Article  PubMed  CAS  Google Scholar 

  42. Milani RV, Lavie CJ, Mehra MR. Reduction in C-reactive protein through cardiac rehabilitation and exercise training. J Am Coll Cardiol 2004; 43: 1056–61

    Article  PubMed  CAS  Google Scholar 

  43. Rahimi K, Secknus MA, Adam M, et al. Correlation of exercise capacity with high-sensitive C-reactive protein in patients with stable coronary artery disease. Am Heart J 2005; 150: 1282–9

    Article  PubMed  CAS  Google Scholar 

  44. Plaisance EP, Grandjean PW. Physical activity and high-sensitivity C-reactive protein. Sports Med 2006; 36: 443–58

    Article  PubMed  Google Scholar 

  45. Shadid S, Stehouwer CD, Jensen MD. Diet/exercise versus pioglitazone: effects of insulin sensitization with decreasing or increasing fat mass on adipokines and inflammatory markers. J Clin Endocrinol Metab 2006; 91: 3418–25

    Article  PubMed  CAS  Google Scholar 

  46. Vigorito C, Giallauria F, Palomba S, et al. Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 2007; 92: 1379–84

    Article  PubMed  CAS  Google Scholar 

  47. LeMaitre JP, Harris S, Fox KA, et al. Change in circulating cytokines after 2 forms of exercise training in chronic stable heart failure. Am Heart J 2004; 147: 100–5

    Article  PubMed  CAS  Google Scholar 

  48. Hammett CJ, Prapavessis H, Baldi JC, et al. Effects of exercise training on 5 inflammatory markers associated with cardiovascular risk. Am Heart J 2006; 151: 367.e7–16

    Article  CAS  Google Scholar 

  49. Huffman KM, Samsa GP, Slentz CA, et al. Response of high-sensitivity C-reactive protein to exercise training in an at-risk population. Am Heart J 2006; 152: 793–800

    Article  PubMed  CAS  Google Scholar 

  50. Rokling-Andersen MH, Reseland JE, Veierod MB, et al. Effects of long-term exercise and diet intervention on plasma adipokine concentrations. Am J Clin Nutr 2007; 86: 1293–301

    PubMed  CAS  Google Scholar 

  51. Campbell KL, Campbell PT, Ulrich CM, et al. No reduction in C-reactive protein following a 12-month randomized controlled trial of exercise in men and women. Cancer Epidemiol Biomarkers Prev 2008; 17: 1714–8

    Article  PubMed  CAS  Google Scholar 

  52. Stewart LK, Earnest CP, Blair SN, et al. Effects of different doses of physical activity on C-reactive protein among women. Med Sci Sports Exerc 2010; 42: 701–7

    PubMed  CAS  Google Scholar 

  53. Church TS, Earnest CP, Thompson AM, et al. Exercise without weight loss does not reduce C-reactive protein: the INFLAME study. Med Sci Sports Exerc 2010; 42: 708–16

    PubMed  CAS  Google Scholar 

  54. Nicklas BJ, Ambrosius W, Messier SP, et al. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. Am J Clin Nutr 2004; 79: 544–51

    PubMed  CAS  Google Scholar 

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Acknowledgments

All authors have made a substantial contribution to the information or material submitted for publication, and all have read and approved the final manuscript. No author has a direct or indirect commercial financial incentive associated with publishing the article. Sources of funding are indicated. Neither this manuscript nor portions thereof are under consideration by another journal or electronic publication. This work has not been previously published.

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  1. Department of Urology, Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA

    Andrew Michigan, Timothy V. Johnson &  Viraj A. Master MD, PhD

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Michigan, A., Johnson, T.V. & Master, V.A. Review of the Relationship between C-Reactive Protein and Exercise. Mol Diag Ther 15, 265–275 (2011). https://doi.org/10.1007/BF03256418

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